Statins are universally loved – as prevention for cardiovascular and cerebrovascular disease, as a cholesterol lowering drug – they even prevent cancer. We often give high dose statins immediately after an acute coronary syndrome – and we know they can prevent stroke – so when’s the best time to give them?
Back in 2006, The SPARCL investigators had a look at giving a high dose statin, in this case 80mg of atorvastatin, straight after a recent stroke or TIA. The hazard ratio for a stroke was 0.84, with a reduction in both ischaemic strokes but a small increase in haemorrhagic strokes. Cardiovascular events were also reduced, but the overall mortality was similar. Adverse events overall were equal between the statin and placebo group.
So, we know that statins prevent further ischaemic strokes, but when do you start them?
This study looked at over 8,000 patients between 2000 and 2007, and found that statins = survival. Whether it was before, during or after admission, patients did better, and if it was all three, then they did the best. Critically, starting a statin immediately in hospital improved 12 month mortality, compared with those who started it just a few days later.
Don’t wait to start a statin – it should be on the drug chart from day 1 of admission. Definitely going to see more trials in this down the track.
Check out the 2006 article over at NEJM, here, and then read the latest over at Stroke (search for the name Flint in the PDF), here.